Advocates of pay-for-performance believe that physicians can improve their performance. To do so, many will need to acquire additional knowledge and skills. The record shows that physicians who have been in practice for a long time have worse average scores on various measures of quality; they may be apt targets for educational initiatives (27).

This need for learning presents a remarkable opportunity for medical schools, postgraduate training programs, continuing medical education credit-granting programs, medical and specialty societies, and certifying boards. The recent trend toward requiring performance assessment to maintain one's specialty board certification might serve as a basis for certifying boards or specialty societies to collect the performance measures that pay-for-performance programs would use. The utility of these professional databases to serve these 2 purposes may be limited because health plans require data on current performance and some certification programs measure performance at 10-year intervals. In fact, performance data may flow to the certification programs, which will reduce reluctant collection burdens for physicians.